According to data from the recent Effort study, published by The Lancet, adequate and early nutritional care in hospitalized patients can reduce mortality by 35% and poor clinical outcome by 21%. These data, according to the research authors, would “firmly” support the concept of nutritional screening and evaluation at the time of hospital admission and the immediate introduction of individualized nutritional support in the case of patients at risk.
These conclusions become even more important in the case of Covid-19, an infection that, like others, has a negative impact on the nutritional status of patients, but which, according to Dr. Carmen Gómez Candela, head of the Nutrition Unit Clinic and Dietetics of the La Paz University Hospital in Madrid, "has shown spectacular aggressiveness in this regard with the establishment of very severe cases of malnutrition in a very short time."
According to the manifesto of the Malnourished Alliance on Addressing Disease-Related Malnutrition in patients with COVID-19, patients affected by Covid-19 can develop "malnutrition related to acute disease with inflammation" for different causes: among them the increased energy requirements with difficulty covering them due to hyporexia, the existence of a severe inflammatory situation and the coexistence of feeding difficulties; to which, in the case of Covid-19 infection, there are symptoms of this disease such as nausea, vomiting and diarrhea, which affect both food intake and absorption.
Increased risk in hospitalized patients
The risk of malnutrition associated with infection by the new coronavirus is higher in hospitalized patients since, as explained by Dr. Francisco Pita, member of the Nutrition area of the Spanish Society of Endocrinology and Nutrition (SEEN), "they are usually more severe , and have higher nutritional requirements ”; some factors to which others associated with hospital malnutrition are added "such as prolonged fasting due to tests, altered palatability or changes that had to be made in hospitality due to the pandemic." In this sense, the expert recalls that SEEN promoted "an approach with high nutritional density diets, including adding oral nutritional supplements to correct these factors from the start."
This was done at the Hospital de la Paz, where, as Dr. Gómez Candela explains, any patient with a Covid-19 diagnosis who could eat was automatically supplemented with hyperprotein formulas. "Nutritional treatment has been one of the pillars on which the disease approach has been based and from our position we have used all the arsenal that we have available: diet modifications, modifications by food modules, supplementation, enteral nutrition and nutrition parenteral, because the fundamental thing was to nourish the patient in a very exquisite and early way before he lost weight, since if we waited for that weight loss or that they could not swallow we were already late ”.
Even more serious was the case in those patients who have undergone a critical care unit such as the ICU, in whom the syndrome of acquired weakness is very present and in whom enteral nutrition has been the first option. "Patients lose weight and muscle mass, requiring intensive nutritional and rehabilitative treatment for several weeks after discharge from the ICU," says Pita. An opinion shared by Gómez Candela, who points out that they have seen “impressive” muscle mass losses that have been combated with the use of hyperprotein formulas “enriched in calcium or vitamin D for the recovery of muscle mass”.
How to increase caloric and protein density
As Dr. Carmen Gómez Candela assures, all Covid-19 patients have been at risk of malnutrition. Even the mildest who have not needed hospitalization "have easily lost 8-10 kilos", something that according to the expert has been due to the metabolic effects of the virus itself and the lack of appetite derived from one of the symptoms of the coronavirus, the loss of smell and taste perception.
In this sense, to fight against the risk of malnutrition, SEEN has made a series of recommendations with the aim of increasing the caloric and protein density of daily food ingested in order to provide a greater amount of nutrients in more food portions. little. Among those recommendations, the following stand out:
Increase the number of meals a day to an average of between six and ten, even if they are not large, so that it is possible to increase the caloric and protein intake without feeling satiety.
Chew well and eat slowly, taking the necessary time.
If you have a poor appetite, it is important to always start your meal with protein food, regardless of whether you make two high-density dishes or single dishes.
Do not base food on soups or broths, since these only provide water, but not nutrients.
Drink plenty of liquids (water or infusions), but always outside of meals, separated from them at least 30 or 60 minutes). Natural juices or homemade smoothies are also included in this between-day fluid intake.
Both lunch and dinner should always include meat (150 g), eggs (2 units) or fish (150 g).
Enhance the caloric content of the dishes: Purees crushed in whole milk and accompanied by cheeses, ground nuts, egg whites, meat or fish; legumes always with rice, little soupy and with added protein; rice and pasta with minced meat, grated cheese, ham or tuna.
Whenever possible, choose multigrain bread, with seeds or nuts.
Try to accompany fruit consumption with yogurts or prepare it in smoothies.
Employ cooking techniques that add calories to the dish, such as batters, breaded, stews with stir-fries.
